Three-dimensional left atrial strain analysis in patients with atrial fibrillation for stroke risk evaluation: A comparison between patients with and without stroke history.

Evaluation of early diagnosis and progression to heart failure with preserved ejection fraction: A retrospective study in patients with arterial hypertension and left ventricular hypertrophy.

Background: Postoperative atrial fibrillation (POAF), the most common arrhythmia following coronary artery bypass grafting (CABG), increases both morbidity and hospital stay. Objectives: To assess the predictive value of intraoperative transesophageal echocardiography (TEE)-derived left atrial (LA) indices for POAF after CABG, with the primary endpoint being the incidence of POAF. Methods: A prospective cohort study was conducted at Mansoura University hospitals from January 2022 to January 2023, including 70 adults undergoing on-pump CABG. Patients were classified into atrial fibrillation (AF, n = 18; 25.7%) and No-AF (n = 52; 74.3%) groups. Comprehensive TEE was performed before and after cardiopulmonary bypass (CPB) to assess LA dimensions, left atrial appendage (LAA) area and flow velocity, left atrial kinetic energy (LAKE), and left atrial ejection force (LAEF). Data were analyzed using multivariable logistic regression to identify independent predictors of POAF. Results: The POAF occurred in 25.7% of patients. The AF group was older (66.6 ± 6.1 vs. 61.1 ± 10.0 years; P = 0.031), with a higher prevalence of hypertension (HTN, 83.3% vs. 53.8%; P = 0.027) and prior myocardial infarction (MI, 77.8% vs. 26.9%; P < 0.001). They exhibited a larger LA transverse diameter (4.21 ± 0.23 vs. 4.08 ± 0.19 cm; P = 0.007) and LAA area (3.66 ± 0.62 vs. 2.84 ± 0.26 cm2; P < 0.001), but lower post-cardiopulmonary bypass (post-CPB) LAA velocity (0.39 ± 0.10 vs. 0.63 ± 0.05 m/s; P < 0.001). Intensive care unit (ICU) and hospital stays were longer (4.0 ± 1.1 vs 3.2 ± 0.9 days; P = 0.002 and 7.9 ± 2.1 vs 5.4 ± 2.0 days; P < 0.001, respectively). Independent predictors of POAF included HTN [odds ratio (OR) 5.32; 95% confidence interval (CI) 1.2 - 23.8; P = 0.029], prior MI (OR 9.40; 95% CI 2.2 - 40.1; P = 0.003), pre-cardiopulmonary bypass (pre-CPB) LA transverse diameter (OR 30.43; 95% CI 2.2 - 42; P = 0.011), and pre-cardiopulmonary bypass end-systolic diameter (pre-CPB ESD, OR 5.10; 95% CI 1.9 - 13.2; P = 0.001). Protective factors were higher post-CPB LA appendage maximum velocity (OR ≈ 0.001; 95% CI 0.01 - 0.004; P = 0.022) and post-CPB left upper pulmonary vein systolic-diastolic ratio (LUPVSDR, OR ≈ 0.001; 95% CI 0.002 - 0.014; P = 0.003). Conclusions: Transoesophageal echocardiography-derived parameters, especially LA enlargement and reduced appendage flow, independently predict POAF after CABG and may guide perioperative prophylaxis.

Background: Atrial fibrillation (AF) is a common arrhythmia with serious complications. Identifying its risk factors is crucial for prevention and treatment. This study aimed to identify independent risk factors for AF in arrhythmia patients at Cho Ray Hospital. Methods: This descriptive cross-sectional study included 272 patients treated for arrhythmia between December 2023 and May 2024. Data on clinical history and paraclinical indicators were collected. The prevalence of AF was determined, and both univariate and multivariate logistic regression analyses were used to investigate the association between potential risk factors and AF. Statistical significance was set at a P-value <0.05. Results: The study found an AF prevalence of 14.7% in the patient group. Univariate analysis showed that age, heart failure, left atrial (LA) dimension, and estimated glomerular filtration rate (eGFR) were significantly associated with AF. However, a multivariate model identified only LA dimension and a history of diabetes as independent risk factors. For every one-millimeter increase in LA dimension, the risk of AF increased by 19.8% (OR=1.198, 95% CI: 1.093-1.313). Diabetic patients had a 3.4-fold higher risk of AF compared to non-diabetic individuals (OR=3.421, 95% CI: 1.021-11.466). Conclusion: The findings suggest that an enlarged LA and a history of diabetes are independent risk factors for AF in this patient population. These results provide an important basis for early screening and management to improve outcomes for arrhythmia patients

Early identification of abnormalities in vascular and cardiac structure offers an opportunity for intervention to reduce future cardiovascular disease (CVD). This study examined factors contributing to increased CVD risk from adolescence to young adulthood. Raine Study participants (n=716) classified as low- or high-CVD risk using cluster analysis at 17-years were re-studied at 27-years. Outcomes at 27-years were vascular stiffness assessed by pulse wave velocity (PWV), and left ventricular mass index (LVMI), left ventricular (LV), right ventricular (RV) and left atrial (LA) myocardial strain and respective ejection fractions (EF) assessed by cardiac magnetic resonance imaging. Outcomes were compared according to low- or high-risk classification at 17-years adjusting for sex and significant covariates at 27-years.At 27-years, individuals classified as high-risk at 17-years had significantly increased PWV (males: 6.6±0.12 vs 6.2±0.04 m/sec; females: 6.2±0.10 vs 5.6±0.04 m/sec) and LVMI (males: 75.2±2.1 vs 69.7±0.5 g/m2; females: 55.4±1.0 vs 52.1±0.4 g/m2) compared with low-risk individuals. Compared with low-risk individuals, LV global longitudinal strain in high-risk females (-16.7±0.4 vs -17.6±0.17 %, p=0.041) and LV global circumferential strain in males (-19.1±0.5 vs -20.5±0.2 %, p=0.013) and females (-21.3±0.4 vs -22.4±0.2 %, p=0.022) were attenuated. These differences were significant in regression analysis after adjusting for sex and contemporary risk factors. An unhealthy CVD risk profile in adolescence leads to structural vascular and cardiac changes in young adults predisposing them to future CVD. The results emphasize the importance of early public health measures to reduce the burden of cardiovascular and related lifestyle disorders.

The incidence and progression of atrial fibrillation (AF), the most common type of cardiac arrhythmia, correlate with atrial fibrosis. An increased epicardial adipose tissue (EAT) volume is associated with increased atrial fibrosis. Although the presence and severity of atrial fibrosis have been evaluated through various invasive and noninvasive methods, reports examining the association between EAT volume (EATV) and the left atrial (LA) stiffness index through echocardiography or LA compliance as determined by LA pressure are lacking. Therefore, we investigated the relationship between EAT and the LA stiffness index and directly measured LA pressure in patients undergoing AF ablation. We retrospectively examined 165 patients who underwent catheter ablation for AF between December 2022 and March 2025. The EATV was measured using contrast-enhanced computed tomography. The LA stiffness index was calculated as the ratio of the early mitral inflow velocity to the early annular tissue velocity. LA pulse pressure was assessed as the difference between peak and nadir LA pressure. A weak correlation was observed between the LA-EATV index (LA-EATVI) and the LA stiffness index. No significant correlation was observed between the LA-EATVI and LA pulse pressure. Our study showed a weak correlation between the LA-EATVI and the LA stiffness index, but not with LA pulse pressure in patients with AF. Changes in the LA owing to EAT may need to be evaluated quantitatively and qualitatively.

AimThis study aimed to optimize non-invasive echocardiographic evaluation of myocardial function in a mouse model of diastolic heart failure, emphasizing the methodological challenges in assessing diastolic and left atrial (LA) function. Recognizing that clinical human studies frequently assess cardiac performance in non-sedated subjects, this investigation compared systolic and diastolic functional outcomes in mice subjected to heart failure with preserved ejection fraction (HFpEF) using two anesthetic agents: Avertin (mild sedation) and isoflurane (deep sedation). Additionally, we present a histological and echocardiographic correlation of the LA changes in established HFpEF mouse model.ResultsMice received angiotensin II and phenylephrine (AngII/PE) infusions for 28 days, followed by comprehensive echocardiographic and histologic analysis, including advanced diastology and LA assessment. AngII/PE treatment produced a reproducible HFpEF phenotype, with multiorgan involvement. Cardiac function measurements revealed significantly greater declines in both systolic and diastolic function in isoflurane-sedated mice, while mice sedated with Avertin primarily exhibited worsening diastolic metrics. LA histology corroborated imaging findings, showing profound wall thinning, reduced cellularity, and fibrotic conversion by day 28, changes tightly linked to deteriorating diastolic performance.ConclusionThe study highlights the limitations of deep sedation in accurately reflecting physiological cardiac function and underscores the importance of standardized mild-sedation protocols for translational murine heart failure research. Unlike the ventricular thickening and cardiomyocyte hypertrophy typically seen with diastolic dysfunction, LA remodeling was characterized by myocardial thinning and fibrosis, suggesting a distinct and opposite to LV pathogenic process. These findings support prioritizing minimally sedated echocardiographic assessment for better translational relevance.

Prognostic significance of cardiovascular magnetic resonance advanced atrial parameters in chronic significant aortic regurgitation.

Left atrial (LA) and left ventricular (LV) venting during open-heart surgery is essential for myocardial protection, maintaining a bloodless field, and facilitating air removal. However, catheter malposition and inadequate venting are not uncommon because of limited visibility. Although transesophageal echocardiography (TEE) can assist in catheter monitoring, TEE-guided management strategies remain underreported. This study aimed to characterize catheter-related issues and describe effective troubleshooting approaches. We retrospectively analyzed intraoperative TEE findings in 304 patients who underwent open-heart surgery at Kochi University Hospital, including 200 with LV venting and 104 with LA venting. TEE records of catheter-related events and corrective maneuvers were reviewed, and challenges in TEE assessment were identified. No catheter-related injuries were observed. In the LV group, TEE identified failure of ventricular entry (n = 5), impingement on papillary muscles or the apex (n = 18), and catheter-induced mitral regurgitation (n = 11). Residual air was frequently localized distant from the catheter tip. In the LA group, misplacement into pulmonary veins (n = 9) or the left atrial appendage (LAA) (n = 2) was noted. Venting was ineffective in cases of acute LV distension during antegrade cardioplegia or due to Thebesian venous return. In some cases, deep catheter placement resulted in incomplete drainage of the right-sided LA. Both LA and LV venting have distinct pitfalls. TEE facilitates identification and correction of catheter-related problems, but structured training in TEE assessment is essential to optimize outcomes.

As a marker of atrial mechanics, left atrial (LA) strain offers unique insight into the functional impact of heart failure treatments. However, given its complex geometry and contractile pattern, the evolution of global and regional LA biomechanics during pressure overload and subsequent release remains unclear. We performed four-dimensional (4D) ultrasound in mice (n=8) to evaluate global and regional LA kinematics at baseline, 3weeks after transverse aortic constriction (TAC), and 1 and 4weeks after aortic debanding (deTAC). LA maximum volume increased from 11.8±0.8µL at baseline to 30.4±9.4µL after TAC (P=0.0024), returning to baseline after deTAC. LA ejection fraction declined from 68.0±5.8 to 29.1±9.2% after TAC (P<0.0001), partially recovering after deTAC. Global longitudinal strain dropped from 24.8±3.6% at baseline to 10.2±3.7% after TAC (P<0.0001), improving to 18.9±3.5% by 4weeks after deTAC (P=0.0073 vs baseline). Despite partial functional recovery, fibrosis remained elevated after pressure release. Notably, regional strain recovery was heterogeneous, with anterior strain measurements showing stronger correlations with delayed ventricular functional improvement than global LA strain, highlighting the superior predictive value of regional analysis. This approach reveals incomplete and region-specific atrial recovery following pressure overload reversal, offering new perspectives on reverse remodelling and potential prognostic value in heart failure management. KEY POINTS: Advanced 4D ultrasound enables precise assessment of regional left atrial strain dynamics throughout cardiac remodelling. Left atrial strain reveals region-specific remodelling patterns during both pressure overload and its reversal. Functional changes in the atrium, particularly in the anterior wall, serve as early predictors of subsequent ventricular remodelling.

Atrioesophageal fistula (AEF) is a rare but serious complication of atrial fibrillation (AF) ablation, linked to high morbidity and mortality. Esophageal thermal injury (ETI), a precursor to AEF, highlights the need to identify high-risk patients. This study aims to assess predictors of ETI following AF ablation. This prospective cohort study included patients undergoing their first radiofrequency AF ablation between October 2018 and June 2024. Esophageal temperature was continuously monitored using a multi-sensor probe. RF energy on the posterior left atrial (LA) wall was delivered at 40W for up to 12s and interrupted if temperature reached ≥ 38°C. Upper endoscopy within 48h post-procedure classified ETI according to the Kansas City Classification. A total of 391 patients were included (mean age 61 ± 12 years; 73% male; 71% with paroxysmal AF; CHA₂DS₂-VASc 1.7 ± 1.4). Mean LA diameter was 42 ± 6mm, and mean left ventricular ejection fraction was 63 ± 9%. In addition to pulmonary vein isolation, 16% underwent additional ablation lines. ETI occurred in 42 patients (10.7%). Multivariable analysis showed LA diameter as a protective factor (OR 0.920, 95% CI 0.870-0.974, p = 0.004) and higher esophageal temperature as a risk factor (OR 1.813, 95% CI 1.354-2.428, p < 0.001). A predictive model combining both variables stratified patients into low- and high-risk groups (AUC 0.749). All injuries were managed conservatively without progression to AEF. Smaller LA diameter and elevated esophageal temperature during AF ablation independently predict ETI.

Background: Severe mitral regurgitation (MR) is typically associated with large V-waves on invasive hemodynamic monitoring. However, discrepancies often arise between echocardiographic assessments of MR severity using color Doppler and invasive hemodynamic measurements. These inconsistencies are largely influenced by left atrial (LA) compliance, which affects the magnitude of V-waves. We sought to identify non-invasive predictors of invasive LA compliance and V-wave response in patients undergoing transcatheter mitral valve therapies (TMVT). Hypothesis: Which echocardiographic and clinical factors are predictive of invasive LA compliance in patients undergoing TMVT for severe MR? Methods: Patients with severe MR who achieved MR resolution (≤1+ post-procedure) following TMVT by either transcatheter edge-to-edge repair (TEER) or transcatheter mitral valve replacement (TMVR) were included in the study. The compliant LA group consisted of patients with severe MR by color Doppler who had either a baseline LA mean pressure ≤12 mmHg or a concordant hemodynamic response, defined as ≥50% reduction in V-wave magnitude along with MR resolution. The non-compliant LA group included patients with a baseline LA mean pressure &gt;12 mmHg and a discordant response, defined as &lt;50% V-wave reduction despite MR resolution. Multivariable logistic regression was performed to identify independent predictors of LA compliance. Results: A total of 248 patients were included in the analysis, of whom 41 underwent TMVR and 207 underwent TEER. The mean age was 77.3 years, and 63% were male. Overall, 103 patients (41.5%) were classified as having a compliant LA, while 145 (58.5%) were classified as non-compliant. On multivariable logistic regression, two independent predictors of a non-compliant LA were identified: lower LA reservoir strain (OR 1.11; 95% CI, 1.04–1.19; p=0.002) and a history of prior atrial intervention; either atrial fibrillation intervention or left atrial appendage ligation (OR 0.28; 95% CI, 0.09-0.83; p=0.02) (Figure 1). Conclusion: Reduced LA reservoir strain and a history of atrial intervention are significantly associated with lower LA compliance and a blunted V-wave response following TMVT. These non-invasive markers may help identify patients with impaired LA mechanics and inform procedural planning and expectations.

Background: Atrioventricular node (AVN) ablation combined with pacing is a well-established therapy for refractory atrial fibrillation. Traditional right ventricular pacing has been shown to cause ventricular dyssynchrony and may worsen atrial remodeling. Left bundle branch area pacing (LBBAP) provides a more physiological ventricular activation than non-conduction system pacing (non-CSP). However, the effects of LBBAP on left atrial (LA) remodeling and left ventricular (LV) function after AVN ablation in atrial fibrillation patients remain underexplored. We aimed to compare LA and LV functional outcomes between LBBAP and non-CSP in this population. Hypothesis: LBBAP preserves or improves LA and LV function compared to non-CSP in patients with atrial fibrillation following AVN ablation. Methods: We retrospectively identified patients with atrial fibrillation undergoing AVN ablation followed by either LBBAP or non-CSP (biventricular, leadless, or septal right ventricular pacing) between 2019 and 2023. Pre- and post-pacing echocardiograms were analyzed for LA volumes and emptying fraction, LA strain, LV global longitudinal strain (GLS), LV volumes and ejection fraction, and diastology parameters. Changes in these parameters were compared between groups using analysis of covariance, while accounting for baseline differences and clinical factors. Results: In the study group (n=73), 35 patients underwent LBBAP while 38 underwent non-CSP. Mean age was 79.3 years, and 74% were female. After a mean interval between pre- and post-pacing echocardiograms of 17.1 months, LBBAP was associated with greater adjusted improvement in LA reservoir strain (+3.9%, p=0.001), LA contractile strain (-2.1%, p=0.02), and LV GLS (-2.2%, p=0.02). LA volumes and volume indexes were also significantly lower in the LBBAP group compared to the non-CSP group, indicating improved LA unloading following LBBAP (Figure 1). Conclusion: LBBAP was associated with improved LA strain, LV GLS, and LA volumes compared to non-CSP in patients with atrial fibrillation undergoing AVN ablation and pacemaker implantation. These findings highlight the physiologic benefits of LBBP in improving both LA and LV function and further support LBBP as a preferred approach in patients undergoing AVN ablation.

Introduction: Left atrial (LA) myopathy indicated by worsening LA function has been well-established as a predictor of atrial fibrillation (AF) and other atrial arrhythmias. However, its association with ventricular arrhythmias remains unclear. Hypothesis: Higher LA function is associated with lower frequency of premature ventricular contractions (PVCs) and non-sustained ventricular tachycardia (NSVT). Methods: We included 2,074 ARIC participants without prevalent AF who had LA strain measurements at Visit 5 (2011-2013) and underwent 2-week continuous monitoring with Zio XT Patch at Visit 6 (2016-2017). LA reservoir, conduit, and contractile strain were measured by speckle-tracking echocardiography. Outcomes included PVC frequency (PVCs/hour) and NSVT episodes/day. Multivariable regression models adjusted for demographics, cardiovascular risk factors, medications, and cardiac structure/function. Results: The cohort included 2,074 participants with a mean age of 74±5 years; 58% were women and 23% were Black participants. Overall, median PVC frequency was 2.4/hour (IQR 0.4-15.8), and 605 participants (29.2%) experienced NSVT with a median frequency of 0.08 episodes/day (IQR 0.07-0.21). In fully adjusted models, higher LA function was consistently associated with less frequent ventricular arrhythmias. Specifically, each SD increment in LA reservoir strain was associated with 10.3% lower PVC frequency (p&lt;0.01) and 9.8% lower NSVT frequency (p&lt;0.01). Similarly, each SD increment in LA contractile strain was associated with 7.6% lower PVCs frequency (p=0.03) and 6.5% lower NSVT frequency (p=0.03). LA conduit strain showed similar but non-significant trends, with each SD increase associated with 5.4% lower PVCs frequency (p=0.13) and 5.6% lower NSVT frequency (p=0.06). Conclusion: Atrial myopathy indicated by lower LA function is independently associated with ventricular arrhythmias. These findings suggest LA myopathy may reflect global cardiac substrate changes that predispose to both atrial and ventricular arrhythmogenesis.

Background: Patients with transthyretin amyloid cardiomyopathy (ATTR-CM) face a significant risk of cerebrovascular events, even when in sinus rhythm (SR). However, no validated tool exists to identify those at highest risk. Hypothesis: Atrial amyloid infiltration may cause loss of effective left atrial (LA) contraction despite SR, a phenomenon termed atrial electromechanical dissociation (AEMD). We postulate that LA dysfunction, particularly AEMD, increases the risk of cerebrovascular events and could guide preventive anticoagulation at individual level. Aims: To (i) characterize the LA phenotype using speckle-tracking strain analysis, (ii) assess the potential association of LA function with stroke or TIA, and (iii) develop an algorithm to predict 1-year risk of cerebrovascular events in patients with SR. Methods: Retrospective analysis of patients diagnosed with ATTR-CM (Jan 2003–Dec 2023) at the UK National Amyloidosis Centre. LA function was assessed by speckle-tracking analysis. AEMD was defined as SR with absent LA strain contraction. The primary outcome was time to either stroke or TIA. The secondary outcome was AF development. Results: Among 2310 ATTR-CM patients (74.5% wild-type),116(5.0%) had AEMD,757(32.8%) had SR with LA contraction and 1437(62.2%) had AF on anticoagulation. Over 34[IQR18–54] months,5.0%(n=114) patients experienced the composite outcome of stroke/TIA and 30.9%(n=270/874 in SR) developed AF. AEMD was associated with an increased risk of stroke/TIA compared to SR with LA contraction (HR:3.10,95%CI1.95-4.96;p&lt;0.001) and to AF on anticoagulation (HR:10.62,95%CI6.21-18.16;p&lt;0.001)(Fig 1). AEMD also conferred greater risk of AF development(HR:2.40,95%CI1.80–3.19,p&lt;0.001)(Fig 1). These finding were consistent across the 3 main genotypes (wild-type, T60A and V122I), the 3 NAC disease stages and disease-modifying treatment/enrolment in clinical trials. A flowchart for predicting 1-year risk of stroke/TIA was developed combining transmitral A wave and LA contraction. A-wave ≥90 cm/s ruled out stroke/TIA with sensitivity 96.6% and NPV 98.7%. In patients with A-wave &lt;90 cm/s, worse LA contraction was associatied to a higher risk of stroke/TIA(HR1.28,95%CI1.10–1.50,p=0.001). Risk increased stepwise, peaking in AEMD (9.5 events/100 pt-years)(Tab 1). Conclusion: LA dysfunction, especially AEMD, confers greater risk of stroke/TIA and AF risk in ATTR-CM patients. AEMD may identify high-risk patients who could benefit from preventive anticoagulation.

Introduction: Left atrial (LA) strain is associated with important outcomes including atrial fibrillation, stroke, dementia, and heart failure. Several individual cardiovascular (CV) risk factors are associated with LA strain, but there is limited knowledge about the relationship of a comprehensive CV health (CVH) assessment and LA strain. Moreover, it is unknown if change in CVH impacts LA strain. Hypothesis: Low or declining CVH is associated with reduced LA function. Methods: Using data from the Atherosclerosis Risk in Communities (ARIC) study we characterized CVH at midlife (Visit 2: 1990-92) and late-life (Visit 5: 2011-13) using the American Heart Association’s Life’s Essential 8 (LE8) score. LE8 scores were categorized into low (0-49), moderate (50-79), and high (80-100) CVH. Participants were assigned to one of four categories based on change in CVH over time: 1. healthy/improving – high V5 CVH; 2. healthy/slow decline – high CVH at V2 and moderate at V5; 3. moderate – low or moderate CVH at V2 and moderate at V5; and 4. low/declining – low CVH at V5. The primary outcome was LA strain (reservoir and conduit) measured by echocardiography at V5. Linear regression was used to evaluate the association of the four CVH groups and LA strain values and logistic regression was used to evaluate the association of CVH with abnormal LA reservoir strain defined as &lt;28.9%. Models were adjusted for age, sex, and race/center. Results: This analysis included 4,766 participants free of CVD at V2. Their mean (SD) age was 54.8 (5.0) years at V2 and 75.5 (5.1) years at V5; 41% male and 19% Black. Totals in each CVH subgroup were 362 healthy/improving, 718 healthy/slow decline, 2,780 moderate, and 906 low/declining. Moderate or declining CVH was associated with worse LA reservoir and conduit strain compared to those with high CVH (Figure). Abnormal LA reservoir strain was nearly twice as likely among those with low/declining CVH compared to the healthy/improving group (OR 1.98, 95% CI 1.51-2.61). Conclusion: Establishing and maintaining high CVH in midlife may prevent development of LA dysfunction, an early marker of CVD. Future studies could test interventions that improve overall CVH using change in LA strain as an outcome.

Introduction/Background: Left ventricular (LV) diastolic function is a key prognosticator in both disease and the general population. Given the physiological atrioventricular coupling, LV diastolic function is reflected in left atrial (LA) deformation. LA reservoir strain (LARS) is the most established index, despite being derived from the systolic phase, due to prior limitations in temporal resolution and reproducibility—now addressed with cardiac magnetic resonance imaging (CMR). Other LA indices may better reflect LV diastolic function than LARS. Research Questions/Hypothesis: To investigate LA strain indices by CMR and assess their association with LV diastolic function, compared to LARS. Methods/Approach: This preliminary cross-sectional analysis included patients post-COVID-19. Clinical and demographic data were extracted from medical records. CMR with CINE, T1 map, and late gadolinium enhancement (LGE) was performed on a 3T scanner (Canon Galan). CINE images were acquired with segmented bSSFP (FS=3), with reconstructed temporal resolution of ~25-33ms. Images were analyzed on a commercial workstation (Medis Suite 4.0.50.2). Demographic and CMR measures were summarized by tertiles of LV diastolic function, defined by LV maximum strain rate at early diastole (LVSRe). Correlations between LVSRe and LA indices were assessed, adjusting for demographics that differed across tertiles. Statistical significance was set at p&lt;0.05. Results/Data: Overall, 160 participants with a median of ~20 months post-infection were included (Table 1). Better LV diastolic function was associated with female sex, lower body mass index (BMI), higher heart rate (HR), and enhanced LA and LV systolic and diastolic function, but not with LA volume, booster pump function, or the left atrioventricular coupling index (LACI). LARS did not differ between the middle and upper tertiles, whereas LA passive SR (LAPSR) differed significantly across all tertiles. The correlation between LVSRe and LAPSR, adjusted for sex, BMI, and HR, was stronger than with LARS ( r = -0.47 and r = 0.26, both p&lt;0.01) (Table 2, Figure 1); these trends remained after further adjusting for age and cardiac comorbidities. Conclusions: LAPSR is a better indicator of LV diastolic function than LARS, consistent with its physiological role as a diastolic-phase index and counterpart to LVSRe. Advances in CMR support the utility of LA indices beyond LARS.

Background: Obesity is associated with left atrial (LA) and left ventricular (LV) dysfunction, however, there is little information on when left heart structural and functional changes begin to appear. To clarify this, we assessed left heart geometry and function in obese healthy infants. Methods: Two-dimensional echocardiography was performed in 186 infants aged 4 months. Subjects were divided into 3 groups according to body mass index (BMI): normal (n= 110), &lt;18.0 kg/m 2 ; overweight (n=45), 18 to 19.9 kg/m 2 ; obesity (n=31), ≧20 kg/m 2 . LA volumes (maximum, minimum, and pre-atrial contraction) were measured using speckle tracking echocardiography. LA total emptying fraction, passive emptying fraction, and active emptying fraction were calculated. LV end-diastolic volume, ejection fraction, mass, and mass/volume ratio, mitral annular myocardial velocities during early (Em) and late diastole (Am), and myocardial performance index were assessed. Results: Results are shown in Table. Systolic blood pressure was significantly higher in the obesity group than in the normal and overweight groups. Compared with the normal groups, LA volumes (maximum, minimum, and pre-atrial contraction), LV end-diastolic volume, and LV mass were significantly higher in the overweigh group and the obesity group. LV mass/volume ratio as an index of LV hypertrophy was significantly greater in the the obesity group than those in the normal groups. Compared with the normal group, LA active emptying fraction as an index of LA pump function was significantly higher in the obesity group. Mitral annular myocardial velocity during late diastole in the obesity groups was significantly higher than that in the normal group. There were no significant differences in ejection fraction, mitral annular myocardial velocity during early diastole, myocardial velocity ratio (Em/Am), and myocardial performance index among the 3 groups. Conclusion: Infant obesity is associated with left heart chamber enlargement, LV hypertrophy, and increased LA pump function, which may be compensatory. Thus, obesity-related changes in left heart geometry and function begin to appear in infancy. Our data support the importance of preventing obesity from early infancy.

Background: Tuberculous pericarditis (TBP) remains a life-threatening extrapulmonary manifestation of tuberculosis (TB), particularly in regions with high TB prevalence. It often presents with pericardial effusion, cardiac tamponade, or progression to constrictive pericarditis (CP) and even hemodynamic compromise. While echocardiographic assessment of ventricular function is well established and left ventricular ejection fraction (LVEF) frequently preserved, subtle myocardial dysfunction may go undetected without advanced imaging. The prognostic role of atrial strain abnormalities, particularly left atrial (LA) and right atrial (RA) reservoir strain remains inadequately defined and underexplored. Objective: This study evaluates the prognostic implications of LA and RA strain abnormalities in patients with TBP, assessing their association with clinical outcomes and disease progression. Methods: A retrospective, multicenter study was conducted in 668 patients with confirmed TBP, (mean age = 37 years, mean LVEF= 56%, 57% male). All patients underwent comprehensive echocardiographic assessment, including two-dimensional speckle-tracking echocardiography for LA and RA reservoir strain analysis. Clinical outcomes were tracked over a defined follow-up period of 2-years. Multivariate Cox regression models were used to determine independent predictors of MACE. Results: Impaired LA and RA reservoir strain were observed in a significant proportion of patients despite preserved LVEF. Patients with reduced atrial strain values had higher rates of CP (p &lt; 0.01), RV failure (p &lt; 0.01), and all-cause mortality (p = 0.02). RA strain abnormalities were particularly associated with RV dysfunction and adverse hemodynamic profiles. Inflammatory markers (CRP, ESR) were significantly elevated in patients with atrial strain impairment, suggesting ongoing pericardial inflammation. In multivariate analysis, reduced LA and RA reservoir strain independently predicted MACE, even after adjusting for age, sex, HIV status, effusion size, and baseline ventricular function. Conclusion: In TBP, LA and RA strain abnormalities serve as sensitive indicators of subclinical cardiac dysfunction and strong independent predictors of adverse outcomes, including progression to constriction and death. These findings underscore the value of atrial strain imaging in early risk stratification and highlight the need for timely therapeutic intervention in those with strain abnormalities, even with preserved LVEF.

Introduction: Atrial fibrillation (AF) serves both as a cause and a perpetuating factor in the progression of heart failure (HF). While left ventricular (LV) and left atrial (LA) dysfunction are recognized as prognostic markers, their relative prognostic contributions in patients with AF have not been fully elucidated. Hypothesis: This study aimed to investigate the prognostic significance of LV and LA strain in patients with AF. Methods: Among 921 patients with AF who performed echocardiography between 2009 and 2022, a total of 552 patients (mean age 69 ± 12 years, 39% female) were included after excluding those with significant valvular diseases, LVEF &lt;50%, cardiac implantable devices, prior cardiac surgery, or inadequate image quality for strain analysis. The primary outcome was a composite of all-cause death and HF hospitalization. Patients were categorized into four groups based on LV global longitudinal strain (GLS) (&lt;18.0%) and LA reservoir strain (LARS, &lt;12.2%). Results: During a median follow-up of 4.6 [2.4 – 7.2] years, 134 patients (24%) experienced the primary outcome, including 40 deaths (7%) and 94 HF hospitalization (17%). Patients with reduced LARS had worse outcomes compared to those with preserved LARS (log-rank p &lt; 0.001) ( Figure 1 ). In multivariate Cox regression analysis, patients with reduced both LARS and LV GLS showed (HR 1.69, 95% CI 1.10 – 2.62, p=0.018) the highest risk of adverse outcomes, even after adjusting for clinical and echocardiographic parameters ( Figure 2 ). The group with reduced LARS but preserved LV GLS also demonstrated a higher event rate and a significant association in univariate analysis, though this did not remain significant in the multivariable model. Conclusions: In patients with AF and preserved LVEF, combined impairment of LA and LV strain was independently associated with worse clinical outcomes. Although isolated LA dysfunction was not an independent predictor in multivariate analysis, its association with increased event rate highlights the potential prognostic role of atrial mechanics in this population. These findings suggest that incorporating LA and LV strain into routine assessment may enhance risk stratification in AF.